Culture shock.

[mendeleyev]

GoodOleBoy, thank you!   

[Misha]

Integration takes time. Here is one example. My wife was shocked the first time to hear that if she was sick that she could not go directly to a gynecologist and that in Canada we have to go to our family doctor first and he will refer us to a specialist if necessary. I had to listen to a long rant about how Russia was so much better because you could go to a gynecologist immediately. This was when my wife was in the middle of her really bad culture shock phase.

Yesterday, my wife was talking to a friend from Russia. She then started explaining that at first she didn't like the system at first, but now she finds the doctors really competent. She gave an example as to how she was in his office and when she stood up quickly she got a bit dizzy and he immediately asked if she a problem with low iron levels. She said that she had a problem with a touch of anemia in her childhood and he sent off to have tests. She didn't have any problems, but she was happy that he had ordered the tests. So, yesterday, my wife was telling our friend the same thing that I told her over a year ago that family doctor's are generally very competent and can deal with most medical problems people have without having to go immediately to a specialist 

Culture shock is something you live through, it takes time, but it does pass. This is a great piece on how to cope with culture shock: http://www.bbc.co.uk/dna/h2g2/A2848359.

[Ronnie]

I hear a lot of familiar stories here.  My wife also graduated from driving school without having any ability at all to actually drive.  My wife also was upset that she couldn't just go directly to a specialist under our HMO plan.

I took on a project when I married my wife.  There were other ladies who drove well and spoke English.  But this lady endeared herself to me like no other could.  As I write this she is wiping down my monitor and desk while talking to a friend on the phone.  I'm enjoying a cup of tea and brownie that she offers me 3 or 4 times a day.  Life is good.

 I feel like after 4 1/2 years, we have reached the middle of the forest and are now close to passing through her adjustment trial.  Patience is indeed, the greatest of all virtures.

[kievstar]

Misha, your lucky.  Most family doctors in USA are incompetent.  I am lucky I have some relatives who are doctors and they tell me over the phone what I need before I visit the family doctors.  I than can quickly get the family doctor to give me the referral I need to see a real doctor.  The specialists in the USA are very good but family doctors are hit or miss.  My experience with doctors in Ukraine is very bad but will save that to a different thread.

[Misha]

Misha, your lucky.  Most family doctors in USA are incompetent. 

That is why Canadian family doctor's usually don't have a difficult time finding a job in the United States.

[Dave13]

Mendeleyev, Driving in Moscow your a very brave man.   I think we all find different ways to help our wife's adjust to living in the US. But we need to understand what they have given up to me with us, their country, friends and most important family. These ladies can overcome problems that would kill most of us. 
Dave

[docetae]

My wife has had her culture shock during her first week:
- About the way that women are dressed, she even asked me about one if she is a woman or a man.
- About child education, care and to be polite are very important for her and she was shocked by the lack of respect and of discipline by some children/parents
- About shops, she needed a new pair of boots for snow after her arrival, and her second day in Canada was spent in shops...

We realized that we live with 3 differents culture, mine, french, canadian where we live, and her, Ukrainian. We have a lot of communication and so far, so good !

[ScottinCrimea]

Misha, your lucky.  Most family doctors in USA are incompetent.  I am lucky I have some relatives who are doctors and they tell me over the phone what I need before I visit the family doctors.  I than can quickly get the family doctor to give me the referral I need to see a real doctor.  The specialists in the USA are very good but family doctors are hit or miss.  My experience with doctors in Ukraine is very bad but will save that to a different thread.

Okay, kievstar, I'm feeling obligated to step in here.  I wouldn't agree that "most" family doctors are incompetent.  However, I would agree that many are.  The problem I have seen is that there was a shortage of family physicians so they were quite liberal with allowing foreign grads into the country to practice.  There are also bad specialists, but the acceptance process for the specialty residencies weeds out many.  Be sure that your family doctor graduated from an American medical school and completed a residency in family medicine and your odds of him/her being a competent one go way up.

[kievstar]

Scott, I have a ton of experience with doctors.  Here are a couple of my serious injuries - not all I have had( I am only 37 years old):

Cancer neck 3 vertebra fused - late 1980's surgery and 5 months neck halo (took 3 years to discover problem and hundreds of various doctor visits and testing to determine what is wrong).  90% of the doctors I met were idiots - thought problem was I was growing to fast.

Torn ligaments knee - 1987 (football) - easy to see what was wrong doctor did good job.

Broken navicular bone 1993 (cage fighting) - easy to see what was wrong doctor did good job.

Complete tear of patellar tendon (knee cap slide almost to ankle) - beach volleyball near Toronto Canada 1994.  Supposedly best hospital in Toronto told us to go to USA as better doctors there.  Was not an issue over payment as my father was going to give them cash upfront.

May 2005 - Illegal immigrant drunk hits me at 50 plus miles an hour in Troy Michigan at 8:30 in the morning - my car was stopped for a long time at red light (Alien dies as my trailer hitch goes through his head - thankfully I drive a Suburban with a boat trailer hitch or I would have been dead to).  In ambulance was considered medically dead.  Third time in life doctors said I was medically dead.  Seen more than 50 doctors since than and hundred plus hours of rehab and just had surgery on November 17th in Milwaukee for a microdiskectomy and hopefully this will be the trick.  After surgery was over on November 17th when they transferred me from surgery bed to recovery bed the rails broke and took a header into the floor and got a concussion.  Was supposed to be in bed 1-2 months but fly to Ukraine one week later and got on one knee and proposed to my future wife.  Hurt like hell but was worth it. 

December 2006 - poisoned in shooters bar in Kiev.  Saw 4 different doctors in Kiev and visited the American type hospital there as well.  No one knew what is wrong.  Think I have the flu they say - eventhough body turning colors.  Flew back To USA and went to emergency in Milwaukee - found problem in 1 hour.  Pumped stomach and a bunch of other stuff for one week.  I even mentioned to the Ukraine doctors I think I am poisoned.  I told the Milwaukee doctors  I was poisoned so they test right away. 

I also from 1994 to 1998 audited most of the big hospitals in Northern Ohio and Michigan including University of Michigan, Cleveland, Port Huron, Saginaw, Detroit Medical Center, and the Catholic Hospital chain.  During these audits you see all the legal cases detail and have to speak with doctors and question them on their procedures. 

I have scars, documents, and medical bills to prove all of the above.

Most doctors are incompetent just like most professions in the World.  Be careful who your doctor is and it does not matter what school they come from.  Doctors are good at fixing symptoms they see.  They are terrible in most cases treating the problems they cannot see.

[krimster]

Kievstar
My worst experience in a hospital in Ukraine was in the Chernigov children's hospital in January 1998.  During Orthodox Christmas I brought toys for the children there, hoping to have a "noble uplifting experience".  After handing out presents I was given a tour of the place. I noticed a closed section and asked what it was and was informed that it was the Children's Oncology ward, the director did not want me to go in, which compelled me to insist on it, so we did.  What I saw were rows of children covered in filth and unattended, the smell was overbearing of human waste and some strong chemical.  The look on those poor faces was devastating.  I immediately had to go outside and I started violently shaking, either from the cold or from what I had just seen. I learned that these children had been "triaged", because they were incurable and their disease would kill them, not much resources could be devoted to them.  Most had also been abandoned there by their families who no longer came to visit.  They were truly alone in the world.  I had no more presents to give and Christmas was just another day closer to the end for them.  On the long drive back to Kyiv, we passed tumbled down shacks with candles in the windows and old people in dark coats hunched over pulling sleds by the side of the road.  Everything was dark and eerily silent.  The driver sensed my mood, "this is our life", he told me.

[ScottinCrimea]

kievstar,  Looking at your list, the only negative experience I see with US doctors was the case with your neck back in the 80's.  Otherwise it seems you were satisfied with their care, other than the broken bed rail which certainly can't be blamed on the doctor's incompetence.

As much experience as you say you have with doctors, I think it is safe to say I have much more   I will repeat again, that I don't believe that MOST doctors are incompetent.  I have, though spent enough time in the ER fixing the errors of other doctors to know that there are many who shouldn't be practicing medicine.  To indict an entire specialty as you do is not reasonable or fair.

Post treatment audits are nice for the lawyers and insurance companies, but don't reflect much of what happens when the care is actually being given.  For example, when an acutely ill patient came into my ER, I often had maybe 30 seconds to evaluate the patient, diagnose the problem and initiate treatment or he died.  There was no margin for error.  I acknowledge that many times the radiologist or pathologist, given the luxury of time and greater expertise in his area would find things that I had missed or a committee might have found something that could have been managed better, not being subject to the time constraints I was under.  I don't put much value on these audits other than as an opportunity to learn.  For the record, in all my years practicing in such a high risk specialty, I only had one malpractice suit filed against me.  The initial findings were so strongly in my favor that the other party offered to give me a win without going to court if I would agree not to countersue for a frivolous action.

krimster,  I, too have seen some of the extremely poor conditions in health care facilities in Ukraine.  I have been quite surprised by the variance in conditions from one facility to another.  My first experience with a clinic was similar to what you saw, though not so extreme.  I was surprised later to visit clinics where the facilities and equipment were quite good, though certainly not up to US standards.  The hospital my wife was assigned to was formerly a facility for party leaders and was quite nice, unlike most facilities that had been for the general population.  The one overriding sense I got there from spending time with medical professionals was their commitment to practicing the best medicine they could with what little they had.  Their devotion to their profession far exceeded that which I have experienced with the typical US physician.

[Diplomacy]

Scott:

That is one area I see again and again.  The Doctors do care and are passionate about their craft.  The doctor that helped my fiancee's father went to the village and back which is 2 hours drive.

He would not take gifts or money that were offered.  Luckily I found his weakness, it was hunting.  He admired the Ducks Unlimited shirt I had given her father with quite a conversation.  He is now the proud owner of the University of Texas DU shirt, and you would have thought I had just won the lottery.

The reality of the conditions and the little hope of more resources is very much countered with people who care.  It is not just this Hospital either, I get similar reports from.

[mendeleyev]

My worst experience in a hospital in Ukraine was in the Chernigov children's hospital in January 1998.

Krimster, God bless you for doing that! Having spent time in Russian and Ukrainian hospitals and in orphanages, I was very touched by what you wrote.

You may find one of my stories of interest: http://russianreport.wordpress.com/stories-of-life-in-russia/world-cup-soccer-comes-to-ukrianian-orphanages/

[krimster]

Scott,
   What you say is quite true.  In my experience the quality of medical care from one region of the USA to another is fairly consistent due to regulations and accountability.  This is really lacking in Ukraine.  The first hurdle a patient must overcome is bypassing the "scam artists" who are passing themselves off as medical professionals.  For a Ukrainian who doesn't have good access to information this can be difficult, so many of my Ukrainian acquaintances were scammed by medical staff which I detected, that I became a kind of "consultant scam detector".  You're probably laughing at this, but it's true.  When you return to Ukraine, and you have my best wishes if you do, I'd recommend Simashka in Simferopol, I'd bet you probably already have some contacts there.  Along with the bad, there is invariably some good.  My youngest daughter was subject to frequent though not severe respiratory infections, which always caused me extreme anguish.  It was comforting to be able to pick up the phone and call her pediatrician who would arrive a few hours later.  In the USA, you'd have to make an appointment which would be at least several days later.  In the case of a sick child, the most important patient is sometimes the parents who need their fears alleviated, I found I could do so more quickly in Ukraine than in the USA.

I observed that survival in Ukraine is based on your "network", whatever problem you face, you call your trusted friends and ask for a recommendation, anything from a plumber to a doctor, without this network, we'd have been totally lost in Ukraine.

I really wish I had the youth, the vitality, and your skills Scott, I'd be able to make a difference there.  Alas, I discovered I am no saint, my life in Ukraine caused me to be assertive, then angry, then aggressive, and that overpowered all my other emotions, so I left.  Veni, vidi, abscedi

mendeleyev,
  Once, upon a time I was a fund raiser for Orphanage #2 in Sevastopol.  I also constantly harassed my wife about adoption from there, with tears in her eyes, she said no...

One day, the director of the orphanage came under investigation for "selling" orphans, a more or less routine practice a few years ago in Ukraine.  Her real crime was not dividing the spoils correctly.  To divert attention from herself, she gave the names of the orphanage's benefactors, because in Ukraine anyone who claims to be helping someone is VERY suspicious.  I was contacted by the SBU, my crime?  Bringing used clothing and toys to Ukraine without the proper documents and customs fees.  My wife made one phone call (see network, above), and the investigation ended, as did my involvement with Ukrainian orphanages.







 

[groovlstk]

One day, the director of the orphanage came under investigation for "selling" orphans, a more or less routine practice a few years ago in Ukraine.  Her real crime was not dividing the spoils correctly.  To divert attention from herself, she gave the names of the orphanage's benefactors, because in Ukraine anyone who claims to be helping someone is VERY suspicious.  I was contacted by the SBU, my crime?  Bringing used clothing and toys to Ukraine without the proper documents and customs fees.  My wife made one phone call (see network, above), and the investigation ended, as did my involvement with Ukrainian orphanages.

Krimster, I understand more and more why you're so bitter about your time in Ukraine.

[Ronnie]

The poverty and corruption are enough to make anyone bitter and jaded.  How did this all happen?  There is one and only one answer...70 years of soviet socialism and one-party rule.

Can anyone explain to me the greatest mystery of them all...why do most cities in the FSU still to this day, have their main boulevards or squares named for Lenin and Marx?  These were the very men who are responsible for the failed social experiment using human guinea pigs who may now not recover for another 70 years.

[krimster]

Groovlstk,
   Thanks for the sympathy, I had many trials and tribulations in Ukraine.  However, compared to native Ukrainians, I had a very privileged and luxurious life style.  I was protected by my wealth and little blue passport.  They were not.  While I complained about my life there, they were stoicly silent.  Their silence served them the way my grievances served me.

Ronnie,
   The fact that Ukraine declared independence on Aug 24, 1991, didn't mean that Soviet institutions and culture abruptly disappeared.  They didn't.  They still linger, and are the biggest obstacle to progress there.  Homo Sovieticus is still the dominant species in Ukraine. 

The idea that the Soviet system would create a new, better kind of person was first postulated by the advocates of the Soviet system; they called it the "New Soviet man". Homo Sovieticus, however, was a term with negative connotations, invented by opponents to describe what they said was the real result of Soviet policies. In many ways it meant the opposite of the New Soviet man, someone characterized by the following:

Indifference to the results of his labour (as expressed in the saying "They pretend they are paying us, and we pretend we are working"), and lack of initiative.

Indifference to common property and petty theft from the workplace, both for personal use and for profit. A line from a popular song, "Everything belongs to kolkhoz, everything belongs to me" ("все теперь колхозное, все теперь мое"), meaning that people on collective farms treasured all common property as their own, was sometimes used ironically to refer to instances of petty theft.

Isolation from world culture, created by the Soviet Union's restrictions on travel abroad and strict censorship of information in the media (as well as the abundance of propaganda). The intent was to insulate the Soviet people from Western influence; instead, "exotic" Western culture became more interesting precisely because it was forbidden. Soviet officials called this fascination "Western idolatry" (идолопоклонничество перед Западом).

Obedience or passive acceptance of everything that government imposes on them. Avoidance of taking any individual responsibility on anything.

Russian and Ukrainian Television is full of examples of "nostalgie", a desire to return to the supposed greatness of the past.  This also seems to remove any desire to make changes to improve the future, and so on and so on...

[Diplomacy]

I found a lot of people telling me at least they knew what they were to expect in Soviet Times.  That this is just the same song different verse in their eyes.  The reality of the influence and manipulation Russia still exists over Ukraine.

Western views, with Soviet corruption is not Democracy.  Free market is not really that free. Subsidized gas for heating that you have no control of is not independence.  It is a hybrid and believed that is what a free market is suppose to be. 

70 years is a long time, and normal is reality to them.  One reality that I am not a member of and thank God it is not mine. 

Where to fix?

Major populations in the City where there are things to do.  Village which is really what the Ukraine should focus on.  The strengths of the nation are mining and agriculture.  Of course the adding of a movie theater and a disco would go a long way for a village. 

Then there is at least a job and a life for them there.  Money being generated and a sense of accomplishment. 

What happens though, Oh yes.  You got to hand over whatever the Mafia thinks they are entitled too from your efforts.  So something similar to the Pizza trials would need to take place.

The mining in Ukraine is the most dangerous in the world.  More deaths per ton coal mined than anywhere in the world.  A serious look at investing in modernizing that area by the government would be great.

The citizens are dependent on the government and it is hard to change that.  Socialized Medicine, low wages, subsidized gas, pension system, inadequate housing, an over all taxed and ineffective infrastructure.

Where to start?  Somewhere I guess, but to work it takes money and effort.  It is a real catch 22 over there.  Just keep on keeping on is all we can do.  Doing nothing is the last option, and hope we do not get to that.



The government is too busy with infighting to accomplish anything and are powerless to enact any policy. 

[kievstar]

Scott,  I was auditing there books they were paying KPMG and Ernst & Young to have accurate financial statements.  A lot of malpractice so we had to work with lawyers to determine the legal liability on the books.  Than we sold consulting services on how they could improve - in most cases many doctors were fired and hiring practices improved.  Malpractice is a huge cost of hospitals which causes some hospitals to cut corners on other things.  I personally do not sue people and refused to take money from the hospital for the bed rail breaking.  The doctor was talking with my mother when he got the call that I had fallen.  I liked my doctor but his grand father was born in Odessa.  I have had very good experience with male Russian doctors and female Indian doctors.  

I will agree that emergency room doctors are fantastic.  My issue is with the doctors that maybe at one time were good but have not kept up with learning.   For example, I went through a series of three steroid shots this year for my back (S1 issue) - on the 2nd and 3rd shot the doctor wanted me to tell him where to make the shot in the back.  I told him how the hell do I know - he just said lets try here each time. Got no results and waste of my time.  Another doctor told me this year lets try lyrecia drug (spelling) for 3 months and it got worse but he told me to keep using it. I saw another doctor and he told me to stop right away. I can give more examples but I think we will have to agree to disagree.  But my surgeon for my neck was world famous "Doctor Spine" and he was very good - in fact that surgery and my foot surgery are taught to all students at the University of Michigan.  My uncle who is an xray technician found my cancer as for 3 years he saw me in pain and told me to visit his boss.  Took some simple xrays and my uncle and the Doctor found something that did not look right.  But if it was not for my uncle my cancer would have spread and I would be dead.

[ScottinCrimea]

krimster,  I completely understand everything you are saying.  No question that a "network" is one of the most important things one can have if living in Ukraine.  Knowing someone to call who can provide references or fix things for you is indispensable.  As far as detecting the scam consultants, while it was easy for me to spot them, it was rather more difficult to convince many that these were indeed scams.  They are still rather new to the concept of false advertising and are often quick to jump at those things that "sound too good to be true".

I admire your efforts to make a difference in Ukraine and understand your frustrations and ultimate cynicism.  I saw that progression in you and honestly worried that I would fall victim to the same fate.  I guess only time will tell.  I think my professional forced on me a relative emotional detachment that hopefully will prevent this.  I was forced to accept the knowledge that I could only do so much and the rest was out of my hands and go home with the comfort that I had done all within my power.

For all the bad one sees in Ukraine, or anywhere else for that matter, there is much good.  I try to focus on the good, to the point where some say I see only through rose colored glasses.  Make no mistake, the problems in Ukraine are not invisible to me, but to surrender to the cynicism and dicsouragement would do no one any good and take me down a personal path that I choose not to follow.

[krimster]

Scott,
   Rose colored glasses are an absolute necessity in Ukraine, their only drawback is if you choose to take them off some day (which I think is inevitable).  I understood that about you, and it made me determined to knock them off, and you understood that about me. 

As you experience the good and bad Ukraine, you must make the choice between two paths that you have mentioned.  I have completed my journey, but you have not.  I see you now as Frost saw himself on the mountain.

TWO roads diverged in a yellow wood,   
And sorry I could not travel both   
And be one traveler, long I stood   
And looked down one as far as I could

I shall be telling this with a sigh   
Somewhere ages and ages hence:   
Two roads diverged in a wood, and I—   
I took the one less traveled by,   
And that has made all the difference.

If it were only me, I'd probably still think the journey is really the destination, and I'd still be in Ukraine, soothing my misery with sex, drugs, and classical music.  However, a quirky universe has made me responsible for other human souls that I love far more dearly than my own (my wife and children), and that compelled me to take the path more traveled, and so here I am in the Texas of all places.  Nothing wrong with my choice, or with yours by the way, we each have our preferences.

So keep on truckin' Scott, wooded paths are tricky things and you can never quite see where they'll lead you, you may end up where you started, or you may not, at least you had the courage to explore it, and I respect that about you.

[dispozo]

New Generation International Charity Fund

http://www.kyivpost.com/nation/32400

[ScottinCrimea]

Nice that of all times we have chosen the holiday season to come to an understanding of each other.  I've never feared the road less traveled. Someone has to make the journey, and if I have the means and the desire to make it worthwhile, it is the proper path to follow.  I have no doubt I'll actually enjoy the journey.

Holiday wishes to you and yours.

[Makkin]

   Merry Christmas everyone,

   Krimster I'm always amazed and in awe when you write from the heart. You are a caring person who god looks upon with favor and love.

   I will buy your first book and I will hope for a happy ending with a heart of gold therein. Keep up the good fight and remember your good deeds are what matters even if you don't realize it.

Makkin

[krimster]

Thank you both for your well wishes, my duty as Santa now calls me, merry Christmas everyone!